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111 Cards in this Set
- Front
- Back
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Cause of angina
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Myocardial ischemia
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Where does angina hurt?
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Retrosternal/ across anterior chest, then radiates to shoulders, arms, neck jaw, or upper abdomen (C8-T4)
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How long does angina hurt?
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Less than 20 minutes.
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When does stable angina occur?
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During activity, in cold, after meals, during emotional times
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Associated factors of stable angina
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Dyspnea, nausea, diaphoresis
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How is the pattern of unstable angina different from stable?
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Crescendo pattern- more frequent/ lasts longer.
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When does unstable angina occur?
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During activity or at rest.
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How do stable and unstable angina respond to NTG?
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Stable responds, unstable doesn't.
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Pathology of unstable angina?
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Plaque rupture, hemorrhage, thrombosis.
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Definition of MI?
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Prolonged ischemia with irreversible myocardial necrosis, most often due to occlusive coronary artery thrombosis.
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How does MI differ from angina in terms of severity, timing, duration, and response to meds?
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Severity- more severe, rapid buildup
Timing- lasts longer than 30m Meds- responds to NTG. |
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Factors associated with MI
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N/V, diaphoresis, weakness, lightheadedness, dyspnea
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How frequently does MI lead to sudden death?
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20% of cases
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Causes of pericarditis?
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Infection (viral, TB, bacterial)
Systemic disease (autoimmune, uremia) Malignancy Post MI Contiguous inflammatory process (lungs) Other (drugs, radiation, hemopericardium) |
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Where does pericardial pain hurt?
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Precordial pain
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Quality of pericardial pain?
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Sharp
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What posture relieves pericardial pain?
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Sitting
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Where does pericardial pain radiate?
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Back, shoulders, neck, epigastrium
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Is fever associated with pericardial pain?
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Yes
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Quality of dissecting aortic aneurysm pain?
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Anterior chest pain that radiates to back, neck, and abdomen.
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What causes symptoms of dissecting aortic aneurysm?
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Partial or complete occlusion of the arteries arising from the aortic, intercostal, and lumbar arteries.
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Symptoms associated with dissecting aortic aneurysm?
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Syncope, hemiplegia, paraplegia.
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Cause of dyspnea of left-sided heart failure?
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Increased pulmonary capillary pressure leads to transudation of fluid into the interstitium and alveoli, causing decreased lung compliance.
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What makes dyspnea of left-side heart failure worse?
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The recumbent position increases blood return, causing orthopnea and paroxysmal noctural dyspnea.
Exertion |
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How fast does dyspnea of left sided heart failure progess?
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Slowly, but may occur suddenly as in acute pulmonary edema.
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What are the NYHA classifications for heart disease?
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Class I: No limitation. No Sx with ordinary physical activity.
Class II: Slight limitation. Ordinary physical activity results in symptoms. Class III: Marked limitation. Comfortable at rest, but less than ordinary activity causes symptoms. Class IV: Unable to engage in any physical activity. Symptoms may be present at rest. |
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What is sinus tachycardia?
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Regular rate at 100-180/m
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What causes sinus tachycardia?
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Fever, exercise, emotion, pain, anemia, CHF, volume depletion, thyrotoxicosis, drugs.
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What is sinus bradycardia?
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Regular rate at less than 50-60/m with sudden onset and resolution
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What may help supraventricular tachycardia?
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Cough or carotid massage.
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What is atrial fibrillation like?
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Irregularly irregular and usually fast
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What are atrial and ventricular fibrillation like?
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Like skipping a beat- irregularly irregular
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What is sinus arrhythmia?
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Rate speeds up during inspiration, but has no clinical significance.
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Name of small and weak pulses in Latin?
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Pulsus parvus et tardus
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Causes of pulsus parvus et tardus?
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Low pulse pressure (SBP-DBP)
Low stroke volume: CHF, hypovolemia/ shock/ severe aortic stenosis Increased peripheral vascular resistance: exposure to cold, severe CHF |
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Causes of large, bounding pulses
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High pulse pressure
High stroke volume/ low PVR- fever, anemia, hyperthyroidism, aortic regurg, AV fistulas, PDA Slow heart rate- increases ventricular filling Stiff aortic walls- aging atherosclerosis |
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What is a bisferiens pulse?
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Double systolic peak seen in aortic regurgitation, with or without stenosis
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What is pulsus alternans?
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A pulse with regular rhythm that alternates between strong and weak as a result of LV failure.
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What is a bigeminal pulse?
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Irregular rhythm- alternates between strong (normal) beats and premature beats
Due to premature atrial or (more commonly) premature ventricular beats |
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What is a paradoxical pulse?
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A decrease in pulse amplitude or SBP by greater than 10 mmHg during inspiration.
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What causes a paradoxical pulse?
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Inflate a blood pressure cuff. Lower it to the level where sounds can first be heard, then lower it until they can be heard throughout the respiratory cycle. The difference should be no more than 3-4 mmHg.
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What causes a paradoxical pulse?
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Cardiac tamponade, constrictive pericarditis, or COPD.
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What are the definitions for hypertension?
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Normal <120 and <80
Prehypertension 120-139 80-89 Stage I 140-159 or 90-99 Stage II >160 >100 |
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What is orthostatic hypotension?
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A fall in SBP >20 mmHg upon rising from supine to standing, especially if symptomatic.
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What are some possible causes of orthostatic hypotension?
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Hypovolemia, drugs, prolonged bed rest, autonomic neuropathy.
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What are the different wave points in measuring JVP?
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A- atrial contraction (peak)
X- atrial relaxation (trough) V- venous filling (peak) Y- atrial emptying (trough) |
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What can change JV pulsation in an individual?
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Eliminated by pressure on the end of the clavicle.
Changes with position. Descends with inspiration. |
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What increases JVP?
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Right sided heart failure.
Pericardial tamponade or restrictive pericarditits. Tricuspid stenosis. |
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What increases the A wave of JVP?
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Tricuspid stenosis
Stiff right ventricle |
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What causes absent A waves of JVP?
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Atrial fibrillation
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What causes prominent V waves of JVP?
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Tricuspid regurgitation.
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Describe a normal left ventricular impulse in terms of location, diameter, amplitude, and duration.
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4th/5th LICS or medial to midclavicular line.
About the size of a quarter Small and gentle amplitude Lasts 2/3 of systole. |
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What causes a hyperkinetic ventricular impulse?
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Anxiety, hyperthyroidism, severe anemia.
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How does a hyperkinetic ventricular impulse differ from normal?
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More forceful tapping.
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What causes an altered ventricular impulse due to pressure overload/ hypertrophy?
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Aortic stenosis, hypertension.
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Describe an altered ventricular impulse due to pressure overload/ hypertrophy.
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More forceful tapping, larger than 2 cm, sustained through up to S2.
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What causes an altered ventricular impulse due to volume overload?
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Aortic or mitral regurgitation.
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Describe an altered ventricular impulse due to volume overload.
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Displaced to the left/ possibly downward, larger than 2 cm, diffuse, often slightly sustained.
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Can you feel the impulse of the right ventricle?
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No.
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What causes an accentuated S1?
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Hyperdynamic states: exercise, anemia, hyperthyroidism.
Mitral stenosis. |
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What causes a diminished S1?
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1st degree AV block
Poor ventricular contraction Calcified and immobile mitral valve |
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What causes a varying S1?
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Complete heart block- atria and ventricles are completely independent of each other.
Atrial fibrillation. |
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What causes physiologic splitting of S2?
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Physiologic splitting seen during inspiration- A2 then P2.
Right sided heart activities are longer than left. Negative intrathoracic pressure increases blood flow to the right atrium, and lung expansion increases pulmonary hangout interval. |
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What causes wide splitting of S2?
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RBBB, pulmonic stenosis, pulmonary hypertension.
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What is paradoxical splitting of S2 and what causes it?
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Occurs in expiration instead of inspiration.
Caused by LBBB and aortic stenosis. |
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What is fixed splitting of S2 and what causes it?
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Equal in inspiration and expiration.
ASD, right ventricular failure. |
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What causes increased A2?
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Hypertension- dilated aortic root
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What causes decreased A2?
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Calcific aortic stenosis.
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What causes increased P2?
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Pulmonary hypertension.
Dilated pulmonary artery. ASD. |
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What causes decreased P2?
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Aging- increased AP diameter of chest.
Pulmonic stenosis. |
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What causes an S3 sound?
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At the end of the rapid filling phase of diastole, the ventricles are expanded and the walls tense. The sudden halt of blood against the ventricle walls makes the sound.
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What does an S3 sound like?
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Low, short, and faint- use the bell.
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Where can you here S3?
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Left- apex
Right- xyphoid |
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What kind of heart gives an S3?
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Dilated.
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When is S3 normal?
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Children, adolescents, end of pregnancy, anemia, febrile states, hyperthyroidism.
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What is an abnormal S3?
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A gallop that denotes serious myocardial dysfunction. Usually seen in older patients with history, symptoms, and signs of heart disease.
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Is S3 systolic or diastolic?
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Diastolic.
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What causes an S4?
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Sudden tensing of ventricular musculature and chorda tendinae.
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When does S4 occur?
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During atrium contraction at the end of diastole.
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What does an S4 indicate with respect to the heart muscle?
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Decreased ventricular compliance.
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Describe the sound of an S4.
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Low pitched, low intensity.
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Where to listen for S4?
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Apex/ lower left sternal border.
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What kind of patients have an S4.
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Occasionally normal in athletes.
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In what other, abnormal patients do you find S4?
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Long-standing hypertension.
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What is an opening snap?
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Early, high pitched diastolic sound heard when the stenotic mitral valve opens.
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Where can you hear an opening snap?
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Medial to the apex along the lower sternal border.
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What are early ejection sounds?
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High pitched sounds that come from opening of the A or P valves.
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What causes early ejection sounds?
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Dilated aorta or pulmonary arteries.
Congenital stenosis or bicuspid A valve. Pulmonic stenosis/ pulmonary hypertension. |
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What is a systolic click?
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High-pitched sound heard at the apex in patients with MVP during mid/ late systole.
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What may be associated with a systolic click?
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A late systolic murmur.
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How are heart murmurs graded?
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I/VI = very faint
IV/VI = palpable thrill VI/VI = heard with the stethoscope off the chest wall |
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What are the 3 qualities of murmur?
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Blowing (high-pitched), harsh (low-pitched), musical (sea gull).
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Describe the cause of an innocent or physiologic murmur.
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Turbulent flow across pulmonic valve without pathology.
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Who gets innocent murmurs?
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Kids/ young adults
Hyperdynamic state |
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When/ where are innocent murmurs heard?
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Midsystole in the 2nd/3rd LIS with little radiation
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Describe grade/ quality of innocent murmur.
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II/VI, blowing quality.
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What position decreases an innocent murmur?
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Sitting.
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When/ where is aortic stenosis heard?
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Midsystole, at the base. May radiate to the LSB, apex, and neck.
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What signs may be associated with aortic stenosis?
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diminished S2
paradoxical splitting of S2 signs of LV hypertrophy or dysfunction S4 gallop Pulsus parvus et tardus |
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What is aortic sclerosis?
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Calcium deposits/ valve stiffening with out stenosis, often in the elderly.
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Describe murmur of aortic sclerosis.
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Midsystolic best heard at base.
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How is aortic sclerosis different than aortic stenosis?
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No associated S2 alteration, LV hypertrophy/ dysfunction, alterations in carotid pulse.
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What is IHSS?
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Hypertrophied IV septum causes systolic anterior motion of the anterior mitral valve leaflet.
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What does IHSS sound like?
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Rough/ harsh midsystolic murmur in the 3/4 LIS that may radiate to apex/ base but not to the neck.
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What other sounds/ findings may be associated with IHSS?
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S4, sustained apical impulse.
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What changes the way IHSS sounds?
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Increases with maneuvers that decrease ventricular chamber size- Valsalva, standing.
Decreases with maneuvers that increase ventricular chamber size and PVR- squatting. |
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Describe the murmur of mitral regurgitiation.
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Holosystoloic murmur best heard at the apex that radiates to the axilla and less to the LSB and base.
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What may be associated with mitral regurge?
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Diminished S1.
S3 with increased and prolonged apical impulse. Increase with inspiration. |
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Describe the murmur of tricuspid regurge.
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Holosystolic murmur best heard at LSB that radiates to the right of the sternum but not the axilla.
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What may be associated with tricuspid regurge?
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Right-sided S3 with increased and prolonged apical impulse.
Intensifies with inspiration. |
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Describe murmur of VSD.
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Holosystolic murmur at 3, 4, 5 LIS, often loud with a thrill that radiates widely.
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